How Mayo Clinic Is Simplifying Prenatal Care for Low-Risk Patients

Executive Summary

Pregnancy is not an illness. Rather, it is the ultimate expression of wellness — creating and carrying new life to fruition. Yet prenatal care in the United States has evolved into a complex regimen of 12 to 14 appointments over the course of a 40-week period, often only to confirm that the expectant mother and her fetus are healthy. Low-risk expectant mothers pay a high price for unnecessary prenatal appointments in the form of time away from work and associated lost wages or personal days, child care costs, and so on. So do health care organizations, in the form of the unnecessary utilization of costly medical resources, including obstetric providers, clinic time, and nursing support. To address this problem, a group at Mayo Clinic led by the Department of Obstetrics & Gynecology developed a model that transforms prenatal care for low-risk pregnancies from a medicalized model to an innovative wellness model.

Pregnancy is not an illness. Rather, it is the ultimate expression of wellness — creating and carrying new life to fruition. Yet prenatal care in the United States has evolved into a complex regimen of 12 to 14 appointments over the course of a 40-week period, often only to confirm that the expectant mother and her fetus are healthy.

Low-risk expectant mothers pay a high price for unnecessary prenatal appointments in the form of time away from work and associated lost wages or personal days, child care costs, and so on. So do health care organizations, in the form of the unnecessary utilization of costly medical resources, including obstetric providers, clinic time, and nursing support.

To address this problem, in 2011 a group at Mayo Clinic led by the Department of Obstetrics & Gynecology launched an initiative to transform prenatal care from this medicalized model to an innovative wellness model. The approach that we developed, called OB Nest, allows women experiencing low-risk pregnancies to reduce their number of in-person visits from the standard 12–14 to eight.

Insight Center

The initial results are encouraging: The new approach has improved mother (and often extended family) satisfaction with the prenatal care experience. And it has freed up obstetricians so they can focus more attention on those women with higher-risk pregnancies. In 2016 it was added as a standard care option at Mayo Clinic in Rochester, Minnesota. We recently secured funding to evaluate the use of OB Nest in a rural community setting, one that would be distinct from the academic setting in which the original study was carried out.

When the initiative was launched, in 2011, its purpose was to empower expectant mothers to engage in the provision of care, optimize the number of appointments required to receive quality care, and maintain the care standards recommended by the American College of Obstetrics and Gynecology.

To accomplish these lofty goals, we partnered with a group of 14 expectant mothers, their OB care teams (nurses, midwife, obstetricians), and Mayo Clinic Center for Innovation (CFI). Together, we engaged in a series of activities aimed at demedicalizing prenatal care for low-risk patients, empowering women to actively engage in steering their care, defining the optimal number of scheduled prenatal care appointments, and utilizing innovative technologies to optimize how we monitored the care provided.

Information and knowledge-based tracking system. Until a few years ago, members of Mayo’s Department of Obstetrics and Gynecology tracked their patients manually and compared notes regarding who was at high risk, what tests might be needed in the future, and when the patient’s next visit would be. From our initial needs assessment, we realized that for OB Nest to succeed we needed an information and knowledge-based tracking system that could pull together all health information needed to inform prenatal care into one easily accessible location.

Once the data needed to develop the solution was identified, information and knowledge-management specialists worked with designers from CFI and care providers in obstetrics to establish a user-friendly method of tracking both low- and high-risk patients. Relevant clinical information can now be retrieved automatically from the electronic medical record system by the OB care team.

The custom IT solution developed for us takes into account the way we provide care to expectant mothers. The automated system pulls together everything we need to know regarding preexisting health, as well as our plan for follow-up visits and related information. An electronic dashboard allows us to easily track and organize our patients according to their needs. We can now quickly identify patients with a high risk of complications during pregnancy and make necessary care plans.

(Note: From the same data-management solution, we provided data to the research team to evaluate outcomes for the OB Nest project, ensuring scientific rigor in our evidence-based practice transformation.)

Home-monitoring equipment. OB Nest employs equipment that patients use in their homes to monitor the fetal heart rate and mother’s blood pressure. Patients are trained in how to use this equipment. Results are relayed to the nursing team by phone.

An online community. A social media community moderated by OB Nest nurses was created exclusively for OB Nest patients. It allows patients to share their experiences and ask questions and get answers that can benefit the whole cohort.

Dedicated OB Nest nurses. Registered nurses in the obstetrics practice assisted with patient care and provided patient education during provider office visits. In addition, they provided support to patients by telephone and moderated social media discussions.

Patients’ expectations. Going into the initiative, we knew that low-risk expectant mothers often expect 12–14 scheduled appointments and believe larger gaps between appointments constitute inadequate care. Part of the consent process in the study included ensuring patients understood what care they were being given in the alternate model. They were also reassured that if at any time they needed to see their doctor sooner than scheduled, they would be able to do so. The positive response to the at-home monitoring and dedicated nurses appeared to outweigh any concerns over fewer visits with an obstetrician, and satisfaction scores after the fact bore that out. We continue these practices today.

Women still receive all the recommended laboratory tests, ultrasounds, immunizations, and patient education of a traditional care path. However, by optimizing current technology, OB Nest makes women active participants in their care and the wellness experience of pregnancy, while reducing the associated costs and time commitment.

Abimbola Famuyide, MBBS, is chair of the Department of Obstetrics & Gynecology at Mayo Clinic in Rochester, Minnesota. He serves on the eEditorial board of The Journal of Minimally Invasive Gynecology and has been a written and oral board examiner for the American Board of Obstetrics and Gynecology since 2011.